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Appllcstlone Will Be promase WhenSubmittedPropertyCompleted.eetaut* I ws.y" . r•
<br /> APPLICATION
<br /> l �` �MorrTransterablo,Reroaabkr,WO Wip�ndabNl 3 _ � $f:PTAGE r
<br /> `JWIRONMENTAL HMTH PERMIT
<br /> Application k ereby made t on nasi l the furl w"area of no San ui Local hMalbl
<br /> r«, AddBusinesa Name IOb O
<br /> t Firm Partners,Addresses and Telephone Numbers
<br /> Business Telephone N0. E0!
<br /> Contri-ow Lloance NO.... r �-JZ_
<br /> L Applicentf Name
<br /> (print l ,,�. •� ►�"rr�' ^
<br /> Phase tslteoll Appllaable Category 11.71 and triN IA tM. IMorrnagartr 6 �
<br /> 1. 0 PUMP1111 VEHICLE PERMIT RE01bTRATION tR011/ACM YWICLEI"
<br /> OlapOfal
<br /> For July 1. June 30.10 .�.....
<br /> Refcrtption{Makefft,Color}
<br /> Serial No
<br /> CAL."LklWM No x� a *Y '�"CAL.UosIMMa gnfaMrat No. `` ,� 'tr ",
<br /> Gal.,Weights A Maaures No. �y ,.�•., sem`
<br /> Vi�l,l� -�.:rFn>f51`T._+.
<br /> EquipmentParking Address
<br /> Z. G PUMPER YARD p
<br /> For July 1; June 30.1A �._.— ,}3 p .,' rx .:
<br /> NO,•O1 Vehicles Stored
<br /> Na,of Chemical Toilets StoredqNI
<br /> ., �+
<br /> 3. O PERCOLATION TEST
<br /> ' 'L x' ,fc � f .'z
<br /> R.S.cit Ft. Name f RAL or R.6.E,NQ tit+ • .1 - �^"s�1 -^ .
<br /> I Telt tion Telt Dati/TIR+►" _ .. w' � ? ' §
<br /> 4. IIANITATION PERMIT -
<br /> Job ressiLocatlo �,
<br /> Owiisr 10-
<br /> C3 CESSPOOL A' -T AA� alayMACK11�i�PL11NT., �
<br /> C1 ,nc TANK> d �+1
<br /> # _Y: �`l }�s 3s } Sy G? '►`�- .1'A ' q..r .e
<br /> 0 PERMANENT. TEMPOF111AY O
<br /> 5. 'L"�''CI tki=L TOILM For July 1,-Jurte au.19
<br /> Type Construction -
<br /> E ul t I 91w
<br /> Chani LOoatlonis)
<br /> No ofUnits --- q pftn Stw6W r►t ..
<br /> S.4 Cl2PACIUOE:TaEAT1MENT PLANT. For JulytlJur130
<br /> O �� $j
<br /> PIard i o",on.
<br /> Plaid.
<br /> ° f
<br /> 7 d ZUNQI%V°`For July 1.-June 30.18:` ," s 4
<br /> I SI2_E..,I ,Lee's Than 1,000 W.FS `Nibrs Th- 1;000$� v
<br /> ODAY,CLEANINgGqf.-ChemicaN tiadlAtitoitnt/Mo '
<br /> 1 hereby certiy that I here prep fed;thla sippticatlon and that,tFW TI►OrK will-@ do�Se,tn�tiocorBartobiNhh
<br /> ordinances,state lawn.and �f',3p lulu Looaillai�ltt'bist
<br /> �,
<br /> a APPLICANT'S SIGNATUREX` � ;•
<br /> fir., 741;59 06
<br /> ; Ea Dw: ANNUALLY- rM '- , `{t s, zRd �#:FQyi, n4T. RE IT.a' rtl
<br /> r BASEEXPLJMfAtN�1fEIILt'fiKi :rREMIttA#IGE� ' t+f Pr w AMOUNT OIJE ICNI CKED ��*; �p .+
<br /> t x 4 3 as Gr 3{!4�dITE�i } 'tSAtE'3 E r 4t - p .:/1101JH i 3• w
<br /> .� -,.FEE 14 A ... ..
<br /> r ii
<br /> LESS - �£ L' .. �Y , 2�{ •± ..� � s +, a- "
<br /> r .s "
<br /> PRORATION �, �yl Gp, ,
<br /> mftus is n 1sin ra d t �yt�V '3 n "'� r�FT� `s r
<br /> OSHER,
<br /> r # •xt7 ". �` l i ._ r �+ rIT
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<br /> ---------------------
<br /> M D�rw v2 � t, mil 7 a r ar a;1
<br /> A}PLICANT.•0IaYU11N ALL COPIei TO: hk LMV1aDMYlNTAL NaS&TH pe tr1T/aAayRMI&S AMt e. TOM AYa..►.Q:so a1M lTOCK"14�CI
<br /> �{� �.I ,;•, r�W�"T�y!.� S, �„a F ���`,.� 4 ,,'d�4 --���.+#" l�,Ry[' ,r� /y..� rj�b9 ��� i �."'y�
<br /> i" fpm
<br /> ¢y� it fir' L is !? + Q
<br /> 1" 11 a-',,flyF�k
<br /> VVy' 7r�.y 'T'b�' 4 •A. S�''f .F ,Ci V7!
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